Do Your Statins and Grapefruit Safely Mix?

Do you take statin medications to lower “bad” LDL cholesterol? Eating grapefruit while taking these drugs can increase the risk of side effects. This warning has led to a lot of questions from people taking this type of medication.

Stanley Hazen, MD, PhD, co-section head of preventive cardiology, says it’s a frequent topic of concern.

“Patients often ask about grapefruit and statins — and whether they can eat the fruit or drink the juice when on statins,” he says.

Luckily for grapefruit fans, there are cases in which a moderate amount should be safe.

How do statins work?

The introduction of statin medications has helped patients:

• Lower LDL (Low-density lipoprotein cholesterol or “bad” cholesterol).
• Lower risk for blood vessel disease.
• Avoid a second heart attack if they have cardiovascular disease.

It’s true that changing your diet and lifestyle can help bring down LDL levels, but sticking to a strict diet and exercise regimen isn’t easy.

Statin medications work steadily and reliably to help regulate LDL levels — even if you come up short on exercise or indulge in a slice of cheesecake once too often. And statins help keep LDL levels in check for those patients who find simple diet and lifestyle changes are not enough.

As with any medication, taking the correct dose of statins is important. High dosages are correlated with increased side effects.

What problems come from grapefruit?

Grapefruit contains a chemical that can interfere with your body’s ability to break down or metabolize certain statin medications.

When statin takers eat large amounts of grapefruit, the level of statins in their blood can increase, raising the possibility of side effects.

Problems can occur for those who are sensitive to statin medications or those who have kidney disease or other illnesses. Side effects from grapefruit-statin interaction are typically mild, such as increase in muscle and joint pain. Severe side effects are rare, but can include muscle fiber breakdown and kidney injury.

Is any amount safe?

Only certain statin medications interact negatively with grapefruit. This is an issue only for lovastatin (Mevacor) and simvastatin (Zocor, or Vytorin) and typically is only problematic at the highest dosages. Alternative statins like rosuvastatin (Crestor), pravastatin (Pravachol), pitavastatin (Livalo) or fluvastatin (Lescol) do not have this potential adverse interaction with grapefruit.

There are several studies about grapefruit and statin interaction, and recent ones suggest that moderate grapefruit consumption can be compatible with taking lovastatin and other statin drugs.

There is no absolute consensus about how much grapefruit a person can safely eat while taking statins, but Dr. Hazen takes a measured approach with his patients.

“I personally tell my folks who have had no issues with taking a statin, ‘Go ahead and eat the grapefruit, but in moderation’,” says Dr. Hazen. “Better they eat a low-calorie fruit — and if we find symptoms of statin intolerance, we can cross that bridge, if need be.”

The original studies linking grapefruit ingestion to delayed statin metabolism involved large quantities of grapefruit juice daily (over a quart), and only showed that blood levels of the medications were increased, raising the potential for side effects.

“A more reasonable level of grapefruit and grapefruit juice consumption has been shown to result in far less effect on statins,” he says, adding that patients should still talk with their doctor before eating grapefruit if they take statins.